The PSA test is kind of like a not-so-smart sentry with very good eyes and ears: it can tell us that something is probably going on , but it is not good at telling us which of the usual suspects is responsible: non-cancerous inflammation of the prostate - probably due to a temporary or chronic infection; benign enlargement (known as BPH for Benign Prostatic Hyperplasia) that happens to so many of us as we grow older; to prostate cancer; to one of several other contributors such as a recent biopsy or sex within a day of the test; or to a combination of some of these. You are probably most worried about prostate cancer with that PSA of 4.5, but cancer is not the most likely cause. While such a PSA is in the zone of concern, it is not a very high PSA.

Still, the PSA sentry has shouted his warning, and it's time for you and your doctor to find out what is going on. It would help to know your age, since the range for normal PSA gradually increases as we get older. It would help to know if a urologist did a DRE (Digital Rectal Exam), and, if so, what he reported. Many experienced urologists can estimate the size of the prostate pretty closely from the DRE, and that is useful to know since PSA from healthy cells is pretty closely related to size; for instance a prostate of 68 cc, which is quite large but would not be rare, would fairly well account for that PSA of 4.5. It would also be useful to know the scores and dates of the last two or three PSAs you have had, if any. Is a urologist checking for infection? Are you taking either of the drugs finasteride or Avodart? Those drugs should lower PSA considerably by shrinking the prostate, and so a PSA of 4.5 for a patient on one of the drugs would be more of a concern.

There are a number of steps that can be taken (should be taken in my opinion as a savvy layman) to check out the likelihood of cancer before having a biopsy done. Those include things like a "free PSA" blood test and a PCA3Plus DRE/urine test.

At this time, when you are not yet involved in the prostate cancer world, it would be good to do some mental preparation in case you do have prostate cancer. The key is to be ready to react appropriately if you are diagnosed with the disease: don't underreact by sticking your head in the sand , but don't overreact by rushing to therapy that might be completely unnecessary if you have a mild case. So many of us have an unreasoned abhorrence to the idea of prostate cancer; we can't stand the thought of having it, even if we have what is almost certainly a very mild case, and we rush into unnecessary treatment that involves expense and frequently some side effects that we could have avoided by keeping our cool . Do you know that prostate cancer is "normal" for most men age 50 and older? By "normal," I don't mean healthy; I mean that it is typical; most of us will have at least some microscopic amounts of prostate cancer, and for most of us, it will never do us any harm. You could think of it this way if you are over 50 and learn you have prostate cancer: those other guys without prostate cancer are the ones who are abnormal.

Remember this: if you are diagnosed with cancer, because it is a slow growing disease, you have probably already had it for many years. That means you already know how to live with it: the way you are now living - you haven't changed; it's just that after diagnosis, you know you have it. There is a large and growing amount of medical research from leading centers that more or less proves that Active Surveillance is a strategy that works very well for truly low-risk men. In fact, researchers in a group in Toronto found that about one in every five of their Active Surveillance patients had PSA doubling times of 100 years or more: in other words, it would take a century or more for each doubling of the cancer. At that rate, even Methusela could have prostate cancer and not give it much attention!

On the other hand, we also now know what indicates agressive disease that clearly needs treatment.

Please get some more information and get back to the board. I hope you will be cleared from concern with prostate cancer, but if not, we can give a lot of help.